Tuesday, February 14, 2017

You may have seen it in a film or read it in a book: a bloody Civil War surgery consisting of an incompetent surgeon, overeager to amputate, chopping off limbs unnecessarily and without anesthesia in a chaotic hospital tent. However, despite its prevalence, this traditional view of Civil War surgeries is mostly myth.

Myth 1: Surgeons amputated unnecessarily and too often.

The Civil War occurred before x-rays and antibiotics—and basic antiseptics, while used, were not used uniformly due to a lack of understanding of germs. As a result, infection was a deadly problem for the wounded, more deadly in fact than amputation. So when a man came in with a bone shattered by a bullet or artillery shell—especially if the bone was protruding through the skin—amputation was often the surest way to save the man’s life, as it would actually reduce the risk of fatal infection. If the surgeon didn’t amputate right away but waited instead, often until infection set in, the mortality rate rose from around 25 percent to twice that. In the Northern hospitals, after late 1862, if there was any doubt about whether a limb should be amputated, three surgeons were consulted; if the majority decided amputation was the right course, a fourth doctor would do the surgery. While there were certainly individual surgeons, especially early in the war, who amputated unnecessarily, surgeons in general were more likely to be criticized by other medical professionals for actually not amputating often enough.

Myth 2: Surgery was performed without anesthesia.

In reality, around 95 percent of operations, at least in the North, were done with anesthesia, often ether or chloroform. The rumor that the surgeries were done without anesthesia, a misconception widespread even at the time, was probably a result of the fact that the anesthesia didn’t always render the patient fully unconscious. Some patients under anesthesia were awake but numbed to the pain; others weren’t conscious of what was going on around them, but their bodies still reacted. Since many surgeries were performed outside—and even when they were done inside there were still bystanders—many soldiers saw the anesthetized patient thrashing around and yelling and assumed that meant he hadn’t been given anesthesia.

Myth 3: Military hospitals and their systems for operating were unorganized.

At the beginning of the war, this was generally true. The Northern military medical system wasn’t prepared for an extended war or for the number of casualties. But after 1862, when Jonathan Letterman was appointed medical director for the Army of the Potomac, things rapidly improved, at least in the North. Among the many changes he made, Letterman required the use of triage, reorganized how surgeons obtained their supplies, developed and unified the ambulance system, and hired hospital administrators.

Because of these and other misconceptions, Civil War surgeons were underappreciated then as well as today. While there were of course exceptions, as a whole the surgeons did the best they could with the knowledge and supplies they had. Walt Whitman—who spent countless hours visiting Civil War hospitals—perhaps summed it up best when he wrote, “I must bear my most emphatic testimony to the zeal, manliness, and professional spirit and capacity, generally prevailing among the surgeons, many of them young men, in the hospitals and the army. […] I never ceas’d to find the best men, and the hardest and most disinterested workers, among the surgeons in the hospitals. They are full of genius, too. I have seen many hundreds of them and this is my testimony.”

Image: Wounded soldiers in Armory Square Hospital, Washington DC; man with amputated arm at left and man with amputated leg at center